The drugs market in B&NES is well understood by the police. However, there has been no decrease in drug demand.1

Prevalence estimates show that B&NES has a higher than national average rate of opiate and/or crack users in the population (1,234, 10.6 per 1000 15-64 population, 8.4 nationally). 2

Keeping waiting times low plays a vital role in supporting recovery in local communities. In B&NES, 100% of drug users wait no more than three weeks to access treatment. This compares to 97% nationally.3

When engaged in treatment, people use fewer illegal drugs, commit less crime, improve their health, and manage their lives better – which also benefits the community. In B&NES, 94% of drug users are engaged in effective treatment (treated for 3 months or more) which is on par with the national average.).4

The progress made by drug users such as abstinence from opiate use and crack use is better than the national average and 79% of clients cease injecting compared to 60% nationally.

Around one in eight 14/15 year olds surveyed in B&NES during 2013 reported having taken drugs in the past, with the main drug taken being cannabis (which is often used with tobacco). Rates of hospital admissions due to substance misuse among young people are significantly lower than national (during 2011/12-2013/14 the admission rate was 43.8 per 100,000 population aged 15-24 years, significantly below the comparable rate for England of 81.3). Furthermore, the latest available rate from 2011/12-2013/14 represents a fall from the previous three year period – from 50.7 per 100,000 population aged 15-24 years during 2010/11-2012/13.

While more children and young people are reporting they do not drink alcohol, and rates of alcohol specific admissions are falling (the latest figures for 2011/12-2013/14 were at their lowest level since at least 2006/07-2008/09), one in three 14/15 years olds surveyed in B&NES reported during 2013 they had an alcoholic drink in the past week.

Smoking rates have been steadily falling. However, around 1 in 25 young people surveyed in B&NES reported they were regular smokers in 2013. Smoking increases with age, becoming more prevalent as children progress through secondary school, and more girls reported they were smoking than boys in 2013 in B&NES. Regular smoking is associated with alcohol and drug use.

B&NES has a significantly higher rate of young people being admitted to hospital for self-harm compared to national (the rate of inpatient admissions during 2012/13 for 10-24 year olds because of self-harm is 456.1 per 100,000, or 197 admissions – significantly higher than the England average of 346.3 per 100,000). A large proportion of these young people will also have a history of alcohol and/or drug misuse – roughly one in three during 2013/14 had a history of misusing alcohol and around one in ten had a history of drug use.

Project 28, the local treatment provider, continues to be a well-attended service, with the number of young people entering drug and alcohol treatment in B&NES increasing steadily over the past three years (having risen from 126 in 2011/12 to 144 in 2013/14), with by far the most common substances used being cannabis and alcohol.

The developing Early Help Strategy in B&NES will seek to identify emerging need for young people in a timely manner. This needs assessment identifies a number of young adults in treatment who stated they were using substances under the age of 18 and did not access the local young person’s treatment service, and will inform the development of the Early Help Strategy.

More than a quarter of adults receiving drug or alcohol treatment services in B&NES live with a child or young person under the age of 18, who may require additional support. Additionally, national and international research estimates that there are around 19 babies born every year to mothers in B&NES who may be born with Foetal Alcohol Spectrum Disorder (FASD).

Substance use plays a key role in identifying and responding to the needs of children at risk of Child Sexual Exploitation (CSE). The treatment service is part of the CSE Virtual Team supporting these vulnerable young people.

The outcomes for young people in treatment are better than national – with 94 percent successfully completing treatment during 2013/14, compared to 79 percent nationally. Furthermore, successful treatment appears to be long-lasting, with very few clients re-presenting into adult treatment – during 2012/13-2013/14, 10 out of 80 clients re-presented to the adult drug treatment service following a successful exit from the young person’s treatment service.

Whilst there were no referrals into treatment during 2013/14 for New Psychoactive Substance (NPS) misuse, there is anecdotal and survey evidence that their use has increased.

Information on groups and activities in Bath and North East Somerset open to adults who are socially isolated, affected by mental health issues, substance misuse or homelessness can be found in the Hope Guide.

What does the data say?

Prevalence in Bath and North East Somerset (Adults, including parents)

The treatment Bulls Eye model has been developed by Public Health England to define the population in need. This uses data obtained from services through the national drug treatment database (NDTMS).

In treatment: Opiate and Crack (OCU) clients in contact with treatment agencies on the 31st March 2013.

In treatment during financial year: OCU clients in contact with treatment agencies during 2012/13 but were not still in contact on the 31st March 2013.

Known to treatment but not treated in the last year: OCU clients that were recorded in treatment in 2011/12 but had no contact in 2012/13.

Treatment naive: Possible OCUs not known to the treatment system in 2011/12 or 2012/13.

Prevalence estimates indicate that the numbers of opiate and/or crack users (previously defined as problem drug users) in the 15-64 population in B&NES have increased over recent years, from 842 in 2009/10 and 1,033 in 2010/11, to 1,234 in 2011/12. B&NES has a higher than national average rate of opiate and/or crack users in the population (1,234, 10.6 per 1,000 15-64 population, 8.4 nationally). 6

Club Drugs: this is a new section following data collection during 2013. Adult club drug users (who do not use opiates) typically have good personal resources, such as jobs, relationships, accommodation. That means they are more likely to make the most of treatment. From April 2013 information on additional new psychoactive substances (NPS) will be collected, and will be reported upon for 2015.7

Number of adults new to treatment citing club drug use (no additional opiate use)

The drug strategy, 'Reducing demand, restricting supply, building recovery: supporting people to live a drug-free life’,8 was launched in December 2010. This precipitated the need for services to be redesigned so that the treatment system is recovery focused as defined within the government strategy. The recent re-commissioning of services during 2012/13 established a seamless integrated treatment system enhancing the client’s experience of treatment. Locally, successful completions in treatment have risen since November 2013 as detailed in Figure 2 and 3.

Public Health Outcome Framework (PHOF) [Indicator 2.15]: a new Local Authority based Public Health performance measure for drug misuse has been established. This is because evidence shows that individuals achieving a sustained recovery outcome demonstrate a significant improvement in health and well-being in terms of increased longevity, reduced blood borne virus transmission, improved parenting skills and improved physical and psychological health.

Proportion of all in treatment, who successfully completed treatment and did not re-present within 6 months 11

2012/13

2013/14

(Q1-Q3)

Opiate users completed and did not re-present (%)

8.6%

7.1%

Non-opiate users completed and did not re-present (%)

32.2%

31.8%

All

14.1%

13.2%

A full comparative review of the PHOF will take place in May 2014 following the release of Q4 2013-14 data. At present, there is a slight decline in clients who have successfully completed treatment without re-presenting. However the recent increase in successful completions identified above will show improvements for this indicator throughout 2014-15.

Health, wellbeing and improving outcomes within drug treatment:

B&NES has a higher than the national proportion of drug users in treatment who are new to treatment accepting a Hepatitis B vaccination (78% as a proportion of eligible clients locally compared to 48% as a proportion of eligible clients nationally). Of those accepting 61% have either started or completed a course of vaccinations compared to 43% nationally.12

90% of current or previous injectors have been tested for Hepatitis C (compared to 73% nationally).13This is a 10% increase on those tested from the previous year.

An improvement in opiates, crack, and cocaine abstinence within the first 6 months of treatment continues to be in line with the national average.14

79% of clients are no longer injecting within the first 6 months compared to 60% nationally.15

27% of clients are working ten or more days in the month before leaving treatment compared to 25% nationally.16

The number of young people entering drug and alcohol treatment in B&NES has been increasing steadily in recent years, with by far the most common substances used being cannabis and alcohol. Numbers in treatment have risen from 126 in 2011/12 to 144 in 2013/14. 17

The following document presents the findings of the needs assessment conducted across Bath and North East Somerset (B&NES) and reports on the future requirements for services for young people who are misusing substances, as well as those who are at risk of misusing substances. The primary purpose of this needs assessment is to identify the needs of young people requiring specialist treatment for substance misuse. It includes recommendations that not only addresses unmet treatment needs, it includes a review of early help and prevention. The inclusion of early help and prevention provides a useful opportunity to better understand the pathways into treatment, wider workforce development and ensuring effective treatment for those that require it.

Drug addiction leads to significant economic and social costs. Evidenced-based drug treatment reduces these and delivers real savings, particularly in crime costs, but also through health improvements, including reduced drug-related deaths and lower blood-borne disease transmission rates. This strong value for money case was recently endorsed by the National Audit Office and is the foundation of central Governments significant on-going investment.18